Early professional (EP) athletic trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or people of color (BIPOC).
To identify challenges during the professional education and transition to practice of EP ATs identifying as BIPOC.
Qualitative study.
Virtual interviews.
Fifteen recently credentialed ATs (13 women, 2 men; age = 26.73 ± 1.41 years, experience = 13.80 ± 4.03 months) who self-identified as BIPOC.
We used an interview guide, validated by peer (n = 1) and expert (n = 3) review, to structure the data collection sessions. Data saturation guided recruitment, and we achieved theoretical redundancy after the final interview. We analyzed the data with a phenomenological approach and used multianalyst triangulation (n = 2) and peer review (n = 2) as credibility strategies.
All participants mentioned being victims of microaggressions because of their race during either their professional preparation, work environment, or both. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to a person who could better understand BIPOC EPs’ experiences. Respondents also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as EPs and felt their professional preparation was stunted by the COVID-19 pandemic.
Participants perceived that their transition to practice was stressful due to the microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be incorporated into athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.
Newly certified early professional athletic trainers who identify as Black, Indigenous, or people of color faced challenges in their athletic training programs as students and within their workplaces as full-time certified athletic trainers.
Their transition to practice came with challenges such as microaggressions, a perceived lack of support, and the need for racially concordant mentoring.
To facilitate smooth workplace integration, early professionals should be mentored as they transition to autonomous practice.
Health care providers of color have distinct challenges they must navigate to fulfill their professional roles, including refusal of care by White patients, patient distrust, and perceived incompetence by White counterparts, patients, or both.1 African American nurses and nursing students experienced racism, marginalization, and isolation in the workforce1 and encountered role conflict, discrimination in the workplace, challenges when serving in leadership positions, and a lack of access to mentorship.2,3 Experiencing discrimination often resulted in discouragement and uncertainty toward careers as nurses. Black nurses claimed their race outweighed their qualities of practice, which hindered their opportunities for advancement.1 Further, a lack of health care professionals of color in leadership roles hindered career advancement.1 Researchers have demonstrated that navigating careers in health care fields can be difficult for nurses of color and often included limits to career advancement and opportunities; the same may be true for other health care professionals.1,2 Support and mentorship from relatable coworkers were necessary for the retention of Black nurses1,2 ; athletic trainers (ATs) who identify as Black, Indigenous, or people of color (BIPOC) should have similar support.
Transition to practice is an important time for newly credentialed early professionals (EPs) that often leaves them feeling full of self-doubt, fear, and overwhelmed by the unpredictability of clinical practice.4 Newly credentialed ATs may have new job placements that will redefine and develop individual identities.5 They may also need to master a new role that can be difficult to manage during the transition.6 The transition to practice from graduate assistantships and graduate programs to working professionals has been studied extensively4,5,7–16 ; however, specific examinations of the transition to practice for ATs who identify as BIPOC are lacking. The experiences of BIPOC EP ATs are likely different than those of their White counterparts because it can be difficult for ATs of color to acclimate to White spaces.17 Although members of historically marginalized groups become credentialed ATs, little is known about their transition from student to autonomous clinical practice. Transitioning to professional practice after credentialing is a vital part of entering the profession, and the experiences of BIPOC EPs should be studied as efforts to improve diversity continue.
Despite abundant research related to the transition to practice in the athletic training profession,4,5,7–16 no authors to our knowledge have explored the transition to practice for BIPOC EP ATs. Therefore, the purpose of our qualitative research study was to identify challenges faced by BIPOC EP ATs during their professional education and transition to practice within the first 1 to 3 years of earning certification. We also shed light on the experiences of historically marginalized individuals to assist with the creation of support mechanisms for entry-level professionals by giving voices to underrepresented diverse ATs. The information can be used to provide resources for BIPOC EP ATs in the profession as well as all ATs, AT educators, and supervisors of ATs. More resources could potentially provide experiences that better accommodate EP diverse ATs in the transition to practice.
METHODS
We investigated the challenges faced by BIPOC EP ATs using a phenomenological design. Qualitative research is identified by a detailed study that allows participants to describe their perceptions of their own encounters with society.18 According to Pitney and Parker,18 a phenomenological study examines the experiences of individual people and their interactions with the physical world. Thus, a phenomenological design was appropriate for our exploration, as we were interested in the perceived experiences and culture of EP ATs’ transition to practice.19 After agreeing to participate, respondents were asked to share their personal experiences as BIPOC EP ATs during the transition to autonomous practice.
Participants
We recruited 15 recently credentialed ATs (13 women, 2 men; age = 26.73 ± 1.41 years, experience = 13.80 ± 4.03 months) who self-identified as BIPOC EP ATs (Table 1). Participants had to be 18 years or older, had to work as full-time ATs, had to have passed their Board of Certification examination within the past 3 years, and could not have worked >3 years as full-time or part-time ATs. We settled on the sample size as data saturation (ie, theoretical redundancy in participant responses) was reached after the 15th interview. For demographic information, we used the following definitions. Race is defined by people who share identical physical features founded upon stereotypical concepts and social constructs.20 Ethnicity is used to identify people by religion, cultural similarities, and language.20
Instrument Development
To structure data collection, we developed an interview guide (Table 2), which peers (n = 1) and experts (n = 3) reviewed to ensure validity. Peer review was followed by expert review to evaluate whether the guide adequately examined our research questions and purpose. Peer review consisted of contacting a peer, who was a faculty member with publication experience in transition to practice, and asking her to review the preliminary interview guide and comment on the clarity, relevance, and importance of the study’s purpose and the research questions. After revisions, 3 experts in athletic training, defined as scholars who have published on diversity in athletic training or had experience with the National Athletic Trainers’ Association Ethnic Diversity Advisory Committee, participated in securing the content validity process.
One content validity tool was dispersed to each expert to obtain individual feedback. All experts rated questions based on clarity, relevance, and importance to the purpose of the study and underlying research questions on a 4-point Likert scale and provided suggestions and comments to improve the style of the questions.21,22 Each question had to have an average score of ≥3 to be included in the interview guide.23 After every content validity tool was returned to the research team, we edited the interview guide and returned a revised guide to each expert with the intention of improving the ratings of the individual questions and the comprehensiveness of the guide. We revised the interview guide again after the second round of edits and suggestions, had it scored again by the experts to ensure all questions averaged a score of ≥3, and then finalized it for pilot testing, participant recruitment, and eventual data collection. We pilot-tested our interview guide with 2 individuals who met the inclusion criteria. Because the pilot testers provided no suggestions for changes, we included their data as the first 2 interviews.
Procedures
After receiving institutional review board approval, we posted the recruitment script to social media platforms (ie, Facebook, Twitter). We included a link that led participants to an institutional review board–approved informed consent form via Google Forms that educated individuals on the study’s purpose, participation, time required, and potential risks and benefits. After agreeing to the terms of the informed consent form, participants were required to input demographics and contact information to schedule an interview. Once they agreed, the lead researcher (A.D.S.) contacted them to schedule interviews. We conducted, recorded, transcribed, and stored interviews via Zoom (Zoom Video Communications, Inc). We used the interview guide (see Table 2) to organize conversations with participants about experiences during the transition to practice as BIPOC ATs. Interviews were conducted based on the chronological order of volunteers who agreed to participate. Interview sessions lasted 46.33 minutes on average.
Data Analysis and Trustworthiness or Credibility
We cleaned each interview transcript for errors and converted it to Google Docs (Google LLC) for analysis. We used a phenomenological approach to establish themes and patterns in the transcripts. Before data analysis, we as a research team bracketed24 our thoughts, feelings, and opinions regarding the purpose of our study and the research questions. Bracketing served as an important step in reducing bias and ensuring the analysis spoke to the data.24 The lead researcher developed themes and theories derived from the quotes that supported the purpose of the study via phenomenological reduction.19 According to the data, we highlighted text based on recurrent statements made by participants. We grouped codes into categories and subcategories and later into overall themes that supported the findings from the data. A triangulation method was used to ensure credible findings in the data.25 Two research team members coded the data independently and then met to discuss the findings. We negotiated over the wording used for the themes before finalizing our findings. We also asked a peer with extensive qualitative experience to review the coding structure and results and verify the authenticity of the presentation.25 We received small suggested wording changes from peers but no suggested edits to the content of the themes.
RESULTS
In our data analysis, we identified 6 themes associated with challenges faced by BIPOC EP ATs transitioning to autonomous practice. Four themes were directly related to race: microaggressions, a desire for racially concordant mentoring, lack of support from work supervisors and program stakeholders, and a need for outside support. Unrelated to race, 2 themes emerged: many participants experienced perceived incompetency from superiors based on the length of professional preparation at the graduate level as well as lingering effects of the COVID-19 pandemic. The last 2 themes were unrelated to our purpose and research questions, so we did not include them in our analysis. The themes are defined and supported with participant quotes in the following sections.
Microaggressions
The first major challenge that arose was the presence of microaggressions. Many of our participants experienced inappropriate racial comments and actions directed toward them. Microaggressions have been generally defined as offensive words and behaviors directed at victims by perpetrators who may be unaware that they have engaged in demeaning manners.26 Most participants experienced microaggressive actions or statements made by coworkers, superiors, and other department personnel in the workplace. Due to the lack of cultural competency in the workplace, insensitive comments were made regarding skin color, hairstyles, and cultural practices. In general, participants also encountered many forms of microaggressions during their educational training and transition to autonomous practice.
Meagan, an African American AT who worked in the high school setting, shared:
I put my hand out to [greet a research fellow, saying], “Hi! My name is Meagan.” He tried to dap me up [description follows in the next paragraph] like I should [swing] out my hand. He was like, “What’s good?” and I just was like, “No, he did not do that.”
Taken back by such an inappropriate greeting, Meagan did not know how to respond. She assumed his greeting derived from her being an African American or biracial woman. Greeting someone with a dap is common within the African American community. Dapping is a cultural greeting in which each person grips the hand into a lock, and then both people embrace with a partial hug. Meagan attempted to greet him professionally with the utmost respect via a traditional handshake.
Maria, a Latina AT, said:
I did work at [college name]. It is a Historically Black College or University. I think because I’m so White passing, everybody thought I was White. It’s like an insult to me. I get it. It was another problem that was really hard for me. It is like trying to earn these people’s trust because of the amount of just absolute disrespect towards different communities in this country, just trying to earn people’s respect and trying to let people know we’re going in the same direction. There was nothing ever glaring. It was just the little things [athletes would say], “Oh, we got another White girl being an athletic trainer for us,” and it’s like, “No, I’m not.”
As an EP, Maria experienced microaggressive comments from athletes. She dealt with racially ambiguous comments relating to her appearance and race. Athletes Maria cared for thought she was a White AT at a predominately African American university. The comments were frustrating for her to hear because athletes often judged her based on her skin tone rather than her racial identity.
Participants also discussed discriminatory encounters that occurred during didactic and educational training before transitioning to practice. Adalia, an African American AT, described:
I would say things a certain way [in class]. For example, I’m from the country, and I’ll talk a certain way, or they’ll make jokes, and I’m like, “Hold on! Watch yourself!” A lot of times people don’t realize what a microaggression is. For example, they [will say], “Oh, you’re pretty for a Black girl,” or something like that. I’m like, “Why? Why can’t you just say pretty?” … I don’t get it.
Adalia expressed her frustrations of being labeled a “pretty Black girl” or “smart Black girl” by her classmates. Her irritation about being the “Black girl” became a battle that she fought frequently within her professional program. Adalia expressed feeling that she was not respected by her fellow classmates and professors as the only African American AT student in her professional program.
Topaz, an African American AT who worked in the college setting, depicted an instance when examples of microaggressions were taught in a course during her professional program:
I believe one of our professors was kind of, you know, [one of those] people [where] they’re going to be inclusive, but when you’re talking about doing an example of the case studies, you have a patient for the case study [who’s] named Lateesha, who has a baby daddy and 4 kids, on Medicaid. That’s the case study example, and her baby daddy [does not] come around. This is not the case that we prepared for the class. I think people may comment that it is insensitive or offensive, [lacking] empathy or caring, and they don’t understand culture as much.
Topaz had some trouble dealing with a professor in the program. She did not understand why stereotypical examples were presented in her academic courses. Topaz indicated that the professor constantly made microaggressive comments directed at the African American population. She also believed her race was an obvious cause of biased treatment from her professor. Mistreatment from her professor affected her grades and academic performance in the professional program:
I believe one of [my] professors was kind of picking on [BIPOC students] based on our race. There are quite a few instances where [microaggressions] occurred. I brought it to her attention or the school’s attention, [and] there was some retaliation. I [used to] deal with a lot of [microaggressive comments]. I had a lot that we had to deal with and just kind of put up with it because, you know, she was over the program. She controlled our grades. You don’t want to get too much on their bad side. It is either you’re at A, B, or C, and you have to get, you know, a certain grade. I was like, let me not push [my concerns] too much.
Shanice, who was an African American AT at a high school, explained a similar incident:
Our program director emailed me and only me, stating, “I believe Black lives matter.” I was very confused. I texted my classmates, and I was like, “Hey, did you guys get an email from such and such around such and such time?” Everybody was like, “No, no, no.” So then I emailed my professor, who is also Black, and I was like, “Ma’am, [I was sent] this email, and I don’t know how to feel,” and then she immediately called me, and she was like, “I knew she was going to do this. I told her don’t do it because it’s like, no, especially only sending it to you.” After that, I always felt off with [my professor].
Delilah said:
[My professor] would say things about our hair. One [of my classmates] that has box braids, [my professor] asked her, “Is your hair always going to be like that?” And just like, “Yes, it’s always going to be like this.” We were just in class taking notes, and [my professor] asked [another classmate], “What’s wrong with your face? Why [does] your face look [displeasing]?” I guess because her face wasn’t looking so pleasant, but it’s like we were in the middle of taking notes. [I’m like], “How happy can you be about taking notes?” Maybe we just have that, you know, resting face that looks mean. I’m not doing something that brings me [happiness] right now, so what do you expect [from students]?
Delilah’s perception was that her professor targeted minority students in a class for their facial expressions while taking notes. In general, participants encountered many forms of microaggressions during their educational training and transition to autonomous practice. Due to the lack of cultural competency in the workplace, insensitive comments were made regarding skin color, hairstyles, and cultural practices.
Racially Concordant Mentoring
Diverse ATs in our study expressed the need for racially concordant mentors. Many participants felt the lack of mentors with whom they could racially identify was a challenge. Respondents observed that building relationships with concordant mentors would have been beneficial during their educational training and transition to practice. Jaquan, a Hispanic AT, had moved to an area where not many Hispanic ATs currently worked. He wished to have mentors who racially identified similarly in order to address the demands of the job:
Now I’m outside of [my previous] setting and on the other side of the country. It’s kind of hard to find a mentor out here that’s in the same boat as me. As of right now, I don’t really have a mentor that looks like me for the stage of where I’m at in the profession.
Jaquan, working in a high school in Arizona, did not have other Hispanic ATs in his area of work.
Colby, an African American AT working at a high school, said:
I think we have a robust amount of athletic trainers of color who want to pour or give back to students. I think sometimes our programs don’t do a good enough job of connecting those individuals together. I don’t think they do a good enough job of doing that. I think sometimes the profession struggles with that because of the program, and I think a lot of struggles that we have as a sort of training will fall back onto the program. I think the program, you know, that’s one of the things I think the program should have is mentorship.
He felt professional programs did not offer networks to build relationships with students of color. He also believed that professional-level programs lacked the necessary tools and resources to connect BIPOC students with experienced ATs, even though such mentors were available.
Lack of Support
We asked participants about having any type of support during the transition to practice and didactic or educational training. Many ATs, while transitioning to autonomous practice, while enrolled in their master’s program, or both, reported having little to no support. During the transition, the lack of guidance or direction from superiors hindered EPs from successfully integrating into the organization. Maria, a Latina AT in the high school setting, said:
If someone tried to disrespect me, I’d be like, “Hey, you’re disrespectful to me. I don’t appreciate this.” My boss actually thought that [speaking up] was not the best idea. She was like, “You knew that you were a female when you took this job and when you were getting into this setting.” That support wasn’t there. She said, “If they yell at you, it’s okay.” My boss would just tell me to deal with it.
The event occurred at the first job Maria obtained after she earned her credentials. She did not expect such a negative encounter from members of the staff without the support of her head AT. Maria began to withdraw from her work as her boss implied that she should accept the disrespectful comments from coaches.
Sadie also felt isolated at work. She said:
I’m the only person [in the athletics department] as a Black female, [and] they’re not going to respect me because they’re used to [the previous AT]. That was kind of a challenge, walking into a school that’s predominantly White. It was just kind of hard to let people know like, “Hey I’m a Black woman, [so] respect me.” You know? I’m here. I work with you, so we’ll see each other every day. [Coaches] still need to respect me, even though I’m not the same as you.
Sadie worked with people who did not respect her as a BIPOC AT. She consistently heard disrespectful comments from coaches in the high school where she worked.
As students, participants felt they could not relate to peers and professors in their respective programs. Topaz matriculated through the program by herself. She stated:
I got through the program with [my family] alone. That was it because nobody else supported me. The school didn’t support me after I told them that [my professor] would make racial comments, and then she was picking on me, and nobody helped me.
She did not receive adequate support during her educational training, nor was discrimination addressed, leading to a feeling of being ignored and having only herself to rely on. Participants wished they were provided the opportunity during their program to discuss concerns or personal problems with someone. Cultivating a relationship with another professional relieved Meagan’s sense of isolation:
I cried a lot, and I was really kind of like beside myself, because no one understood what I was going through. I don’t think anyone really understood what was really going on and how to support me, so I had to find other African American athletic trainers who could understand and relate to me in that way, got linked in with them, and kind of started to like heal.
Her emotional hardships made her experience much more difficult; as a diverse student, she was not provided the support needed to cope with emotions, academic pressures, and mental health conditions.
Delilah said:
[I was told] I just [need to] stick it out. I was like, you know what, I don’t want to be that guy because, if I report [the discrimination], I’ll [have] no one else to back me up. It’s not like I’m the only [BIPOC student] that’s having a problem. [My classmates] are having [problems too]. I’m just okay with being the spokesperson [to speak up] about it, so that was kind of annoying. It made my studies a little bit more difficult, especially with [my professor’s] class, but with me, like I don’t want to say it’s like a badge of honor, but I do have thicker skin. I was able to manage [the discrimination] a little bit better, but it still made the classroom difficult.
Delilah feared speaking up about concerns in the educational program, believing no one would support her if she reported the racial discrimination she encountered.
Outside Support
We asked participants about support during their professional education, during the onboarding process after becoming certified, and after starting their first job. Many described support mechanisms outside of their programs, mostly while they were athletic training students. Ashlyn was asked about support during her clinical immersion at a university. She relied on support from friends as a student rather than program professors and staff. When asked if she turned to faculty or preceptors for support, Ashlyn recalled:
I’ll say not really because sometimes you feel more comfortable with people who you identify with. That’s just given, so my friends [have] honestly help[ed] me with the way I need to be helped. Yeah, I felt supported by like the few other friends.
During their educational training, BIPOC EP ATs endured a sense of exclusion in the professional programs. Many participants relied on outside resources to express concerns or develop a sense of inclusion. Lydia, an African American AT, relied on family and close friends while pursuing her professional degree in athletic training:
A lot of it was talking to my family. I have to say the majority of my support came from outside sources, none of which had to do with the program besides my 2 friends who are still my friends to this day. I’ll call my mother. I’ll call my friends…
Family support allowed Lydia to express personal concerns.
Topaz supported this explanation:
I was the only African American. My cohort had 3 [total students], and I was the only African American, and I was like, oh, I really want somebody who can relate, knows me, and can understand where I’m coming from, and unfortunately, that wasn’t quite the case.
She assumed other students in her cohort would provide support, but she did not receive the type of support she expected. Topaz expected she could connect with fellow students; however, those relationships did not occur with her program cohort. Instead, she connected with close family members.
Keyshia, an African American EP AT, described:
It was outside of the athletic training program where I found my actual support, so a lot of the time I had to like come back to myself and find ways to keep pushing because no one else was going to help me except for me, so I had to dig deep.
Keyshia also relied on outside support during her educational training. Her internal motivation and external motivation from her family aided her while she earned her master’s degree.
DISCUSSION
Athletic training work settings and programs should implement diversity, equity, and inclusion (DEI) training to assist in creating welcoming environments for all. Such training programs should be a mandatory activity for students to start to develop cultural competency, moving toward cultural humility during their career, as they prepare to become autonomous health care providers. Discriminatory acts can negatively affect educational training and cause diverse clinicians to struggle with individuality.20
Racial Microaggressions
Microaggressions were the strongest theme diverse EP ATs experienced during their workplace transition and professional education. Participants reported encounters with microaggressions in the workforce when many individuals transitioned to the workplace. Discriminatory comments and actions also came from their fellow students, professors, and preceptors in their professional programs. Black women ATs have noted similar experiences as racism impeded persistence.27 Currently, the Commission on Accreditation of Athletic Training Education requires DEI content in professional programs. However, what program administrators are doing to implement the standard in professional education is unknown.
Additionally, administrators should establish policies for ATs to report acts of racial discrimination.17 Our findings align with those of previous authors who found that athletic training students were victims of microaggressions during professional preparation.17 Work and educational settings should have brave spaces and counterspaces for BIPOC clinicians and students. Brave spaces permit individuals to voice their concerns about their experiences in a nonjudgmental space.28 Counterspaces, or places where historically marginalized individuals are more at ease, create friendly and supportive environments for facilitating racial discussions, resulting in the elucidation of racial experiences and available practical resources for BIPOC clinicians and students.29
Many participants faced negative encounters in the workspace, leading to a belief that their experiences made their transition to practice difficult. A lack of support from their supervisors required them to navigate through the transition to practice without adequate support. According to earlier researchers,17,20 established staff should provide assistance and advocacy in which EPs feel comfortable reporting microaggressive comments. Policies and procedures that oppose workplace harassment should be addressed. Specific definitions that explain unprofessional behaviors in the workplace should be part of the institution’s policies and procedures.30
Racially Concordant Mentoring
Our findings support those of previous authors who investigated the transition to practice from multiple stakeholder perspectives.13 When asked about any type of support received during the transition, participants wished for BIPOC mentoring programs during their matriculation through the master’s program and into the workforce that would facilitate concordant mentoring networks. Mentors cultivate a conducive environment for students and EPs who need advice, support, and comfort by connecting people with relatable experiences.31 In our study, racially diverse mentors were not accessible to our participants during their educational training, making learning more difficult; participants were not able to connect with their cohorts and professors who were discordant.
Interestingly, our results differ from those of a prior study in which students generally disagreed that ethnicity and sex were important characteristics in developing a relationship with a mentor.32 The differences may reflect that we specifically sought data from BIPOC EP ATs, whereas the earlier work contained responses from professional students who mostly identified as White (87.1%).32 Stakeholders must recognize the struggles faced by diverse athletic training students and EPs in order to create safe and comfortable spaces in professional programs and practice. The benefits of a concordant mentor may include building professional skills and providing a space for mentees to verbalize their concerns while engaging in education and awareness of athletic training. We recommend professional program administrators seek mentoring resources that pair mentors with students who have concordant racial identities. Having resources that support BIPOC students after graduation and through their transition to the workforce can result in better experiences17 in both professional education programs and the workplace, leading to persistence and retention.5,11
Lack of Support
The Ethnic Diversity Advisory Committee of the National Athletic Trainers’ Association developed a mentoring program for BIPOC ATs who are actively seeking mentors within the athletic training profession.33 The resource allows ATs to connect with experienced ATs to work on goals and communication.33 Despite the existence of the mentoring program, participants expressed a lack of support from professional education stakeholders and workplace superiors. Many BIPOC EP ATs had expressed their concerns to supervisors and professors in their athletic training programs but felt their perceptions of discrimination were invalidated, leading them to believe they could not rely on program directors to understand or relate to these problems. Ultimately, participants thought their race hindered the support provided by professors and, more so, by work supervisors. Just as students learn to ask patients questions about identity, intersectionality, and understanding their health effects,34 educators and preceptors should be aware of the same traits in students. Those with coexisting stigmatized identities experience a disproportionate amount of discrimination. Students from historically underrepresented groups can learn resilience through identity affirmation and social support as well as adaptive coping. Unfortunately, a lack of support caused participants to have a sense of exclusion and disassociation from the curriculum and workplace.
Outside Support
Due to the lack of support from student peers, professors, and work supervisors, many participants resorted to depending on outside support, seeking emotional and mental support from family members, significant others, and friends. Our findings mirror those obtained from Black women ATs who relied on family and friends as a support network to facilitate persistence in the athletic training profession.27 Other authors have found outside support networks to be a critical component of stress relief for professional-level students35 and success as EPs working in health care.30 A lack of resources within their professional networks was disappointing to BIPOC EP ATs. Addressing unconscious biases is difficult, especially in communities that are not diverse.36 Assisting students, educators, and preceptors in appreciating the ethnoracial makeup of personal and professional networks and reflecting on whether expansion is needed are steps toward raising awareness of disparities.36 The support BIPOC students need clearly is not available internally, creating a lesser sense of belonging to a health care team.
Recommendations
We recommend educational workshops to help workplace staff recognize negative behaviors such as microaggressive comments, actions, or both.27 Black, Indigenous, and people of color EP mentees can receive career guidance and support from experienced diverse ATs, bringing awareness and analogous experiences to help them deal with challenges during the transition to practice. Athletic training programs and workplaces should ensure an inclusive environment for diverse students and employees. Faculty should provide resources such as racially concordant mentoring to connect students and BIPOC athletic training mentors with similar experiences. Racially concordant mentors can provide advice that may be useful to diverse athletic training students who may have questioned their identity or struggled with confidence, addressing feelings of isolation and being misunderstood by faculty, peers, colleagues, or all of these. BIPOC EP ATs and students who feel invalidated should call on the support of athletic training mentors for advice and guidance. Supervisors should create positive atmospheres to assist employees and create policies to maintain supportive workplace environments.30 Taking actions to support BIPOC EP ATs may motivate and encourage diverse clinicians to persist in the profession as positive interactions between students and program stakeholders (ie, faculty, preceptors)37–39 as well as the program environment38 have been found to alter persistence decisions.
Future Research and Limitations
In this study, we investigated the experience of only 15 BIPOC EP ATs who were <3 years into autonomous practice. Therefore, we caution against broadly generalizing our results to other populations. Our participants exposed several challenges they faced as diverse EP ATs during their transition to practice. Future researchers should explore a greater number of participants with broader racial identities who have recently transitioned to practice. Future authors should investigate how BIPOC EP ATs overcome the noted challenges and if they are able to develop resilience. In our research, we also looked at newly credentialed ATs soon after completion of a master’s degree program. Assessments can be focused on experienced ATs who have worked >5 years in the profession. Different age levels may provoke distinct experiences that did not manifest in our study. In addition, we suggest evaluating the positive aspects of transition to practice for EP ATs who identify as BIPOC. Furthermore, the qualitative approach to understanding differences in the transition to practice for diverse ATs is important. Future researchers may explore the transition to practice for diverse physical therapists or physicians who are EPs. Finally, our last 2 themes (incompetency and the COVID-19 pandemic) appeared unrelated to race, as participants did not connect the experiences to their specific races, leading us to remove them from the paper. We are unsure if the experiences noted in our participants would be similar to those of other EP ATs who do not identify as BIPOC.
CONCLUSIONS
Newly certified BIPOC EP ATs faced challenges in their respective athletic training programs as students and within their workplaces as full-time certified ATs. Their transition to practice came with challenges such as microaggressions, the need for racially concordant mentoring, and a perceived lack of support. All participants mentioned they were victims of microaggressions during their professional preparation or clinical education or in the work environment because of their race. Those who chose to report the incidents felt a lack of support from work supervisors and athletic training program administrators, faculty, peers, and preceptors. Therefore, participants needed mentoring during the transition to successfully integrate into the workspace. Specifically, respondents noted a preference for racially concordant mentors to facilitate talking with a person who could better understand BIPOC EPs’ experiences. In addition, they felt they needed to rely on outside support from friends and family as coping mechanisms. Also, participants’ superiors thought they were incompetent due to their limited experience as EPs. Findings suggested lingering effects of the COVID-19 pandemic on professional education: participants felt they lacked sufficient skills and knowledge for professional practice due to online learning, limited hands-on learning experiences, and reduced clinical education opportunities. Our results suggest a need for resources that may produce a smoother transition to practice for BIPOC ATs. Although the Commission on Accreditation of Athletic Training Education has an educational standard for teaching DEI, how the standard is being implemented is unknown. Training on DEI should be mandatory as part of the athletic training program curriculum and in the workplace. The field of athletic training has a responsibility to support BIPOC EP ATs and validate their experiences as EPs.17 We recommend policies and procedures to protect BIPOC EP ATs from adverse experiences. Early professionals should be trusted and mentored as they transition to autonomous practice in order to facilitate smooth workplace integration.